Short and Sweet Birth Plan

Name/Care Provider/Doula

We’re planning an unmedicated birth.  It is our belief that birth is a normal process; not usually a medical emergency and proceeds in the safest manner without interventions.  Please assist us by offering the least amount of intervention in this normal process. 

• I plan to stay active.
• I would like voices to be kept quiet; especially during contractions.
• I would like to give birth in a vertical position like squatting or hands/knees.
• I would like to follow my own cues for pushing.  Please do not direct me unless baby is in distress or I request it.
• I would like immediate skin-to-skin contact with my baby.
• Please allow the cord to stop pulsing before clamping.
• I do not want routine Pitocin for third stage unless I show signs of excessive bleeding.
• Delay all newborn procedures for an hour after birth.

Thanks for your support in our birth experience,

Signature of couple

Signature of care provider